The Forehead Flap for Nasal Reconstruction

Abstract

Reconstruction of extensive nasal defects often represents a significant challenge owing to several unique qualities of the nose, such as complex topography, mobile free margins, and multiple nasal subunits. Furthermore, loss of internal nasal lining and/or structural skeletal support may be present following removal of extensive skin cancers.Objective: To describe our experience with the use of forehead flap reconstruction for extensive nasal defects.Design: Retrospective case series.Setting: Academic health care hospital system.Patients/Intervention: One hundred forty-seven patients with extensive nasal defects repaired with a forehead flap. Main Outcome Measures:The functional and aesthetic results were assessed. The characteristics of defects repaired with the forehead flap and the need for lining and/or cartilage were examined. Results:The forehead flap was used to repair 147 nasal defects after Mohs excision of nonmelanoma skin cancer. Full-thickness skin was lost in all cases, structural skeletal support in 68 cases (46%), and internal mucosal lining in 45 cases (31%). Our experience and surgical technique using the forehead flap are described. Conclusions:The forehead flap represents one of the best methods for repair of extensive nasal defects. Near-normal functional and cosmetic results can be achieved.

Paramedian forehead flap for nasal tip reconstruction after Mohs surgery

“…Several options are available to restore small mucosal defects (<1 cm) including a turnover hinge flap, turndown of a forehead flap extension, a full-thickness skin graft (FTSG), and bipedicle vestibular skin advancement flap. [5,6] . Except for intranasal mucosal flaps, the other options mentioned may be successfully executed under local anesthesia [1] .…”

Paramedian Forehead Flap for Reconstruction of the Nose

“…Patients should be given wound care instruction, and realistic goals about the final outcome of their nasal reconstruction 5 . According to Nicolas et al report 18 they experienced in 16 patients with a three-staged forehead flap.…”

“…We performed the second stages procedure of this patient after 5 weeks. Baker said the schedule for pedicle detachment approximately 3 weeks following the date of initial flap transfer 5,19 . Although the pedicle may be safely devided 2 weeks after surgey, the shorter interval may limit the ability of pedicle to attenuate the more proximal flap remaining at the recipient site when the flap is to be inset 5,19 .…”

“…When primary wound closure cannot be performed, cutaneous flaps harvested from the nasal skin may be an alternative for repair of centrally located nasal skin defects that measure up to 2,5 cm in greatest dimension 5 . Nasal cutaneous flaps are particularly useful for elderly patients because their skin is lax and mobile 5,6 .…”

“…Nasal cutaneous flaps are particularly useful for elderly patients because their skin is lax and mobile 5,6 . Skin flap for nasal deformity have the advantage of color, texture, and thickness similar to those of the missing skin of the defect.…”